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Contact: John Gentzel, Communications Director, 202-225-4315

Congressman Gerlach’s Statement on the New Cooperation Between the State PACE Program and Medicare

Washington, Nov 30, 2005 - Congressman Jim Gerlach released the following statement today:

“While coming late, it’s encouraging to see that Governor Rendell has finally embraced the new Medicare prescription drug plan, particularly the provisions added to the legislation by myself and the other members of Pennsylvania’s Republican U.S. House delegation that protect thousands of seniors on the state prescription drug plan and provide Pennsylvania with resources to expand coverage for others.

When the legislation passed the U.S. House of Representatives in 2003, Rep. Gerlach joined Reps. Melissa Hart and Tim Murphy in ensuring that any final bill included language that complimented the state PACE program. Because the new, voluntary Medicare benefit will cover the costs of a substantial part of the PACE benefits, Pennsylvania will be able to provide PACE-level benefits at a much lower cost.

According to the U.S. Department of Health and Human Services, PACE beneficiaries do not need to take any immediate action to continue to receive their PACE benefits in 2006. PACE beneficiaries with limited income and assets will receive assistance from the state, Medicare, and the Social Security Administration to enroll in Medicare’s low-income subsidy, which will enhance the coverage they receive and provide additional financial relief to the state. In general, these beneficiaries will pay no premium and only a few dollars for each prescription. Other PACE beneficiaries will receive information and assistance from PACE in the weeks ahead on how their coverage will work with Medicare, and they will experience no reductions in benefits or pharmacies.

According to the U.S. Department of Health and Human Services, the other key features of the agreement include:

• PACE can help people with Medicare identify and enroll in a Medicare drug plan based on their preferences. This will be accomplished by putting information on their prescription usage into a software program, which will provide a list of a subset of available plans based on such features as the particular formulary details and pharmacy networks matching a beneficiary’s recent drug use. The kinds of features to be used, and the guidance provided to beneficiaries, will reflect the guidance on state assistance developed by CMS that is already being used by a range of states with prescription assistance programs.
• Prescription Drug Plans (PDPs) that wish to enroll PACE participants must support a seamless coordination between the Medicare drug benefits and the PACE coverage.
• CMS and PACE officials will work together to make it easier for PACE participants to enroll in drug coverage, much as CMS is working with state pharmaceutical assistance programs in New Jersey, New York, and many other states.

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